Your SlideShare is downloading. ×
SCHOOL HEALTH DATA SYSTEMS RESOURCE
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

SCHOOL HEALTH DATA SYSTEMS RESOURCE

1,167
views

Published on


0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,167
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
24
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. SCHOOL HEALTH DATA SYSTEMS RESOURCE A Resource Guide For Implementing School Health Management Information Systems Massachusetts Department of Public Health Bureau of Family and Community Health Office of Statistics and Evaluation September, 1999
  • 2. TABLE OF CONTENTS 1. Introduction .............................................................................................................................1 A. Rationale for Report ..........................................................................................................1 B. Background .......................................................................................................................1 C. Overview of Report Content ..............................................................................................2 D. How To Use This Report...................................................................................................4 2. Guidelines for Implementing School Health Management Information Systems.........................5 A. Data Integration and Exchange ..........................................................................................5 B. Software Customization .....................................................................................................7 C. Training and Technical Assistance ......................................................................................7 D. Staffing..............................................................................................................................8 E. System Maintenance Procedures.........................................................................................8 F. Security and Confidentiality of School Health Data.............................................................8 3. Considerations for Selecting A Software Package.....................................................................12 A. Suitability of System Design...............................................................................................12 B. Costs..................................................................................................................................15 C. Ease of Use........................................................................................................................16 D. Functional Capabilities .......................................................................................................16 E. Year 2000 Compliance .......................................................................................................17 4. Software Comparison...............................................................................................................18 5. Appendix A. Glossary B. References
  • 3. Acknowledgements This report was prepared by Robert Leibowitz, Alexis Garcia, and Sion Kim Harris of the Office of Statistics and Evaluation, Bureau of Family and Community Health (BFCH). The authors gratefully acknowledge Deborah Klein Walker, Associate Commissioner for Programs and Prevention; Kathy Atkinson, Assistant Commissioner for Policy and Planning; Marlene Anderka, Director, Office of Statistics and Evaluation; Marge MacEvitt, Director, Data Processing; Howard Saxner, Legal Office; and Dale McManis, Office of Statistics and Evaluation, for reviewing this document and providing numerous editorial suggestions. The authors would like to thank Anne Sheetz, Margaret Blum, Diane Gorak, Alice Morrison, and Thomas Comerford of the School and Adolescent Health Unit for their editorial suggestions as well as their work in encouraging school districts in the Enhanced School Health Services (ESHS) program to develop computerized records systems. The authors would also like to thank Robert Rosofsky and Dennis Michaud of the Massachusetts Immunization Information Service (MIIS) for information about their experience with electronic data interchange. Finally, the authors would like to thank all of the school nurses in Massachusetts, especially the nurse leaders in the ESHS program, who have provided feedback about their experiences with implementing school health management information systems in their districts. This publication is also available on the Massachusetts Department of Public Health web site: www.magnet.state.ma.us/dph/ For additional printed copies of this report, please contact the OSE administrative assistant at: Massachusetts Department of Public Health Bureau of Family and Community Health Office of Statistics and Evaluation 250 Washington Street, 5th Floor Boston, MA 02108-4619 (617) 624-5536
  • 4. 1. INTRODUCTION A. Rationale for Report The Massachusetts Department of Public Health (Bureau of Family and Community Health, Office of Statistics and Evaluation) has prepared this report in response to requests from Massachusetts school districts for guidance about the procurement of school health software packages and the implementation of school health management information systems (MIS). School districts face a variety of challenges in evaluating school health software. First, while school nurses are far more computer literate than they were a few years ago, few have developed the level of computer and information systems expertise necessary to evaluate and compare all of the technical specifications, network capabilities, and implementation requirements of the various software packages. In addition, few MIS staff have developed the working knowledge of school health services necessary to understand fully user needs and functional requirements. Furthermore, little comparative or evaluative information about school health software is available, and even comprehensive listings of software packages are difficult to obtain. In addition, no single vendor dominates the market for school health software, so districts cannot simply choose the most popular software package with the expectation that the industry standard will be a safe choice for their district. Moreover, because school health software has been improving rapidly, it may seem prudent for school districts to wait for newer, improved versions before making large investments installing and configuring their systems. At the same time, the current school health software packages are now so easy to use and offer so many advantages in program planning, monitoring, and reporting that the purchase of some software package is becoming increasingly essential. This resource guide is intended to serve as a tool and launching point for school districts in their computerization of school health records. Information is provided on key characteristics of currently available school health software options, and on how to choose and implement a school health computerized information system. B. Background There are few sources of population-wide data on the health of school-aged children. However, this data is critical for the following purposes: • Conducting local, state, and national needs assessments • Monitoring state-mandated programs and screenings • Monitoring compliance with Title V reporting and other federal data requirements • Directing program planning, management, and policy development • Assuring follow-up services after problem identification • Conducting process and outcome evaluations 1
  • 5. Schools are one of the primary sources of information about the health of children because of the central role that schools play in children's lives. Computerizing school health records facilitates data collection, data management, and access control. It makes the data more comprehensive and accurate, while at the same time providing for increased accessibility for health personnel together with heightened security against unauthorized access. In recent years, school health data collection and analysis have become a key part of the development and implementation of the Massachusetts Department of Public Health’s child and adolescent health promotion and primary care program activities. In 1993, the Massachusetts Department of Public Health received funding from the U.S. Department of Health and Human Services, Maternal and Child Health Bureau to develop, and explore the feasibility of implementing, a state-wide computerized school health information system. With this grant, the Bureau of Family and Community Health within the Massachusetts Department of Public Health, in collaboration with the Massachusetts Department of Education and the departments of public health and education in the other New England states (Region I), developed the prototype Model School Health Information System. During this time, the state decided not to develop its own school health software, but to help schools choose their own instead. In order to provide assistance to districts as they made their software purchase decisions, the state initiated a review of school health software and distributed a report containing its findings to interested districts in 1994. We have updated and expanded the 1994 report in this current report. In Massachusetts, an additional effort to expand and standardize the collection of school health data has been underway since 1993 as part of the Massachusetts Department of Public Health’s Enhanced School Health Services (ESHS) program. This program provides funding to selected school districts so that they can expand and improve basic school health services to address the complex and diverse health needs of students and their families. In order to monitor and document services provided and progress achieved, these schools collect and report a variety of information. Computerization of the data enables schools to more efficiently manage the information, enhances their ability to access and utilize the information locally, and streamlines data-reporting to state agencies. Eventually, computerized school health databases located in each district may be able to update related state-wide databases such as the Massachusetts Immunization Information System. The Massachusetts Department of Public Health provides technical assistance to these sites to facilitate computerization through such activities as the generation of this school health data systems resource guide, and providing consultation in the planning, implementation, and maintenance of school health information systems. As we have gained more experience in data collection and school health information systems, we have become more knowledgeable about software choices and systems implementation issues. Through this report, we hope to share what we have learned and to help facilitate the computerization of school health records and information. C. Overview of Report Content The section on Guidelines For Implementing School Health Management Information Systems provides some basic guidelines that are critical to consider for thoughtful 2
  • 6. implementation of school health management information systems. Our recommendations are based upon Massachusetts’ experience in developing the prototype Model School Health Information System and in managing information systems for the state’s Enhanced School Health Services Program for over four years. School districts need to recognize that implementing a school health management information system involves more than just the purchase of software and hardware. There are a variety of factors that determine whether a given software/hardware implementation will be successful over the long run. These success factors include data integration capabilities, data exchange capabilities, software customization capabilities, the availability of training and technical assistance, staffing requirements, the use of backup and other system maintenance procedures, and measures to ensure the security and confidentiality of school health data. The security and confidentiality of school health data is a subject of increasing importance to communities and must not be ignored. In this section we discuss permanent student identifiers, limiting access to school health records, security of the central database (if one exists), record storage, security of documentation at local schools, authorization and training of staff, security of data transmission, and security of data reporting. In the section entitled Considerations for Selecting a Software Package, we discuss the key considerations districts should take into account when purchasing school health software. We address the following issues: suitability of the system design, costs (of software, installation, training, and maintenance), ease of use, and functional capabilities. Finally, one of the major goals of this report is to provide information that can help school nurses, administrators, and MIS personnel choose the school health software package that best meets their needs. In order to make it easier to compare and contrast the features of the various software packages, we have presented in the section Software Comparisons the key software features and functional capabilities in tabular form. Software packages are listed in the rows of the tables in alphabetical order, and specific features are listed in columns and have been grouped into functional categories: • Vendor Contact Information • Software Pricing and Licensing • Software and Hardware Requirements • System Design, Security, and On-line Help • Types of Data Screens Available • Individual Student Record Elements Available • Reports and Other Available Functions (injury reports, screening and referral tracking). • Data Management Capabilities (including data integrity checking, end-of-year processing, the ability to upload and download data), 3
  • 7. D. How To Use This Report Those who intend to purchase school health software will find this report helpful in improving their understanding of the steps involved in setting up school health information systems and to find general information about software packages that might meet their needs. In particular, this report may be used: • To help school districts narrow the possible software options to those packages that are capable of being used on their existing hardware and software platforms. • To identify the type of hardware that would need to be purchased in order to run a particular software package. • To help identify, clarify, and prioritize the software features desired. • To develop an understanding of the design, implementation, and maintenance of school health management information systems. While this report can help districts make more informed software purchase decisions, there are additional criteria that districts also need to consider. This report lists features but makes no attempt to evaluate how successfully each vendor has implemented those features, how easy it is to learn how to use the software, how much customization is required in order to install a system in any particular district, or how much districts might have to spend for training and software customization. Therefore, districts should obtain demo disks (and preferably working trial copies of the software), consult with their MIS staff, follow-up with the vendors’ technical support, and, if possible, talk to nurses and MIS personnel experienced in using and implementing the systems being considered before making a final purchase decision. Also included are price estimates as provided by software vendors. Please note that these are current estimates and are subject to change. 4
  • 8. 2. GUIDELINES FOR IMPLEMENTING SCHOOL HEALTH MANAGEMENT INFORMATION SYSTEMS School districts intending to computerize their school health records not only need to consider software features but also need to evaluate other factors required for successful systems implementation. These factors include A) the ability to exchange data with other databases, B) the ability to customize software to meet local needs, C) training and technical assistance, D) staffing requirements, E) system maintenance procedures, and F) data security. A. Data Integration and Exchange The capability to easily integrate, exchange, and share data with other databases is a highly desirable feature of school health information systems. Such information exchange is likely to become increasingly important in future years as various state and local databases come on-line and policy-makers seek to utilize all available sources of information to inform decision-making and improve local services. School health software packages have a user interface (what might be called the “look and feel” of the software) as well as a “relational database” that defines the data structure and format and provides the technology that allows the user to manipulate the data. The same underlying relational database may be used to develop many different types of applications. Open-standard relational databases leave the data in a standard format so that other database software can access it. If the underlying relational database software is proprietary, however, it leaves the data in a non-standard format. Districts may find it useful to identify the database upon which the software package is built (Access, Oracle, SQL Server, for example) and whether it is compliant with a database interface standard called ODBC that can be used by MIS personnel to access the data. School health software that uses a proprietary (non-standard) database may provide limited import/export and data linkage capabilities, and may require the purchase of additional software or custom programming expense if there is no built-in provision for importing and exporting data in standard formats. Districts may also want to keep track of developments in the School Interoperability Framework (SIF), a recent industry initiative to develop technical specifications for ensuring that the diverse K-12 software applications (including financial management, library, attendance, food service, and health) work together in a simple “plug and play” fashion. SIF provides for standard data formats and naming conventions for shared data, and specifies rules for data interaction. It is intended to eliminate redundant data entry, allow districts to choose the best software applications for their needs and remain confident that all the various applications can “talk to” each other, and make it easier to create powerful data reports that link several databases. SIF has the backing of Microsoft, the Software & Information Industry Association, and a number of school software vendors. As of August, 1999, the SIF specifications were still under development, and no SIF- compliant applications were available. Nevertheless, this is an area undergoing rapid change and development and well worth watching. Current information about SIF can be obtained at the SIF web site: www.schoolsinterop.org/. School health software vendors do not currently use HL7 5
  • 9. (www.hl7.org/), the clinical and administrative healthcare data interoperability specifications being developed by the American National Standards Institute, which is widely used by laboratories, hospitals, and other large patient care facilities. Standardized classification of nursing activities can facilitate the computerization of school nurse activities and are useful for data exchange, data aggregation, as well as for detailed research and evaluation purposes. At present, the North American Nursing Diagnosis Association (NANDA) codes and the Nursing Interventions Classifications (NIC) are the most common. A few software vendors incorporate these types of coding systems into their software. The following are scenarios where data exchange occurs: When students advance grades or transfer schools: Data exchange capabilities allow users of school health software to, among other things, share school health records electronically between schools within the same district when groups of students change grades, and across school districts when students transfer. The development of a set of core data specifications which provide detailed definitions of common data fields can greatly facilitate database integration and aggregation across districts using different software packages. When linking student health records with other student records: The most advanced school health software has some provision for integration of school health records with larger school health information systems combining demographic, health status, health service, and attendance data. This type of comprehensive database can facilitate the coordination of care across health service delivery sites including traditional health care settings. In addition, the relationship between school and health indicators can be explored. When reporting selected data to state agencies: Districts considering purchasing software which integrates administrative and health functions may also want to consider whether their state requires districts to report demographic and related data to state agencies in particular formats. In some states (including Massachusetts), the Department of Education specifies the way demographic (but not health) data elements must be reported; some software vendors provide specialized software modules that meet these requirements.1 Because some data patterns and trends only become apparent when the data is aggregated across geographic boundaries, additional uses for school data aggregated at the district or state level may be developed in the future, and additional data reporting requirements implemented. For school systems where data exchange occurs or may occur in the future, school health software that offers data import, export, and database linkage functionality in a variety of common data file formats is preferable. Defining specifications for common data fields may be 1 The Massachusetts Department of Education (MDOE) requirements can be found at the following web site: www.doe.mass.edu/edtech/administrative/ims/sims_compliance.html. At the present time, MDOE does not have any technical requirements for school health software. However, districts that are considering using software that includes both administrative and health functions should check with the MDOE to make sure that the portion of the software relevant to the MDOE Student Information Management System is compliant with MDOE requirements 6
  • 10. necessary when files are being transferred between different software packages. Some data integration functionality may already be built in to school health software modules that are bundled together with larger school administrative software packages. Data integration and exchange capabilities should be built into the software package and the licensing agreement and should not require any additional expense for software customization. When considering a software package, qualified technical specialists at school districts should review the data interface specifications and ask the software company about how specific data exchange scenarios can be implemented, and whether there are working models of data exchange among users. This information should be obtained before any contracts are signed to ensure that data exchange needs can be met without additional programming expense. The process of data exchange may take place either in “real time” or in regular batch transfers, but ideally should not require programming skills by school health staff and should not be so complex that it cannot be carried out by school health aides with intermediate computer skills. B. Software Customization It is useful to have the ability to easily customize the software by adding data fields for recording additional health services activities or recording medical information. Ideally, adding or modifying data fields should be able to be performed by the user and should not require paying the vendor for technical support or custom programming. In addition, while all packages have some data reporting features, the specific data reports your district requires may not be available in all software packages. Once again, creating custom reports or data queries should be able to be performed by users and should not require custom programming at additional cost. C. Training and Technical Assistance While some software packages are easy to use and can be self-taught by those with basic computer competence, other software packages (especially more complicated systems involving health software modules integrated into school administrative packages) require substantial training. The district’s MIS staff are usually responsible for providing training in basic computer literacy, although they may not be equipped to provide training in health software usage. Districts may need to consider paying for on-site training provided by the software vendor if skilled, computer-literate nurses are not available to take on this responsibility. Even for those software packages that are easy to learn, training will still be necessary to ensure that all nurses in a district are interpreting health encounters and recording health data in a uniform manner. Our experience in Massachusetts has taught us that nurses frequently interpret and record health data in different ways. Consistency and data quality are essential if meaningful data aggregation, analyses, and interpretations are to be achieved. Vendor technical assistance by telephone, with short waiting times and at reasonable cost, is also often essential, especially for districts with limited in-house MIS staff, extensive software customization requirements, and/or special data exporting or importing needs. The cost of this service varies considerably among the different vendors. Some software vendors have also 7
  • 11. established “user groups” with regular annual meetings in regions where a core group of users exists. It may be useful to ask the software vendor whether such groups exist, as they can be of immense value for learning how to use school health software to its fullest extent. D. Staffing In addition to staff required for ongoing training and technical assistance, districts may also need to ensure they have adequate staff for data entry, data cleaning and checking, and data compilation and analysis. Staffing needs in these areas tend to vary substantially by district and with the type of information systems in place. Districts using complex, harder-to-use software packages, or using batch data entry procedures where nurses make written notes of health encounters and then enter data at the end of the day, may require more data and clerical staff. In addition, districts with greater analytical needs may require more analytical and reporting capabilities than those that are built into most school health software packages and will require staff analysts capable of performing the required functions. E. System Maintenance Procedures School district MIS managers must make provisions for performing the routine systems administration and maintenance functions that are required for their school health data systems, including managing user IDs and passwords, network maintenance, security monitoring, virus- scanning, archiving of old data, data backup, and system upgrades. In some systems, data backup happens automatically as part of system administration procedures, without any user intervention. In others, it is the users' responsibility to make backups. Security and confidentiality guidelines need to be followed for all backup storage media (tapes and/or diskettes) as well. Security and confidentiality must be guaranteed if backups are stored off site. F. Security and Confidentiality of School Health Data Confidential or privileged information about individual students and their families must be carefully protected against unauthorized disclosure at all points of information access, transmission, and storage. Guidelines for maintaining the security of school health data are described below. For a more general discussion of information system security in school systems, districts may also want to consult Safeguarding Your Technology (described in the References section of this document), a US Department of Education publication. i) Access Points Potential data access points or locations may include not only the school nurse's office, but also, in a networked system, school administrative offices. Districts with dial-up, remote access systems need to develop strategies for limiting access to pre-approved users. 8
  • 12. Formal data confidentiality and security protection procedures and policies must be put into place for each of these access points so that there is a clear and common understanding of how data should be handled, and who has access to what information. ii) Secure Record Storage All paper records and data diskettes should be stored in a secure place that is protected from unauthorized access.2 This can be a locked filing cabinet, desk or office. Storage must be secure at all times (school days, weekends, vacations, summer). In some school districts, non- nursing staff may have access to health offices during the summer when the nursing staff are typically not there. The security of health records must be maintained at these times. In addition, health records transferred from one school to another should be handled only by authorized health personnel and must not be sent with other school records. In Massachusetts, state regulations require that "the school principal or his/her designee shall be responsible for the privacy and security of all student records maintained at the school" (State Regulation 603 CMR 23.00). The school nurse, in cooperation with the school principal, must maintain the security and confidentiality of any health records stored at the local school. The secure storage of computerized health records must be maintained by the school nurse, who must adhere to all computer security rules and protocols, and the MIS director (or the designated systems security staff person), who must provide technical support for overall information system security, user account administration, and system monitoring. Paper records, diskettes or computer screens should not be left open or in an area where they can be viewed by someone entering the room. It is important to log off from all sensitive computer applications when leaving the computer, even for a short time. All data diskettes should be labeled: Confidential Data: Unauthorized Use is Prohibited. iii) Secure Access to Computerized Records Computers containing school health data should be secured in the following manner. They should be: a) located in a locked area; b) include a start screen that displays the following message each time the database access is attempted: "This database is confidential: Unauthorized access is prohibited"; c) include password protection for system access and health database access; and d) include a password-protected screen-saver which blocks the screen and only allows the screen to reappear if the appropriate password is typed. Staff responsible for backing up the system should ensure security of backup copies of files. iv) Security of Paper Documentation at the Local School Print-outs and other such documents with personal identifiers attached to student information should be stamped confidential, locked in file cabinets when personnel are away from their desk/office, and not taken out of the building unless for a home visit. Confidentiality and security must be strictly maintained at these times and documents should be returned to the appropriate files as soon as possible. Moreover, when disposing of these documents, they should 2 In Massachusetts, procedures taken to safeguard the security of student records must be done in compliance with the Massachusetts Department of Education regulations governing student record privacy and security (603 CMR 23.05). 9
  • 13. be shredded prior to disposal. When sending and receiving faxes containing such data, it is recommended that the sender call the receiver to notify her that a confidential fax has been sent. The receiver can then stand at the fax machine at the time the data is being transmitted to limit unauthorized access. Secured fax machines located inside health rooms are recommended. v) Authorization & Training of Staff Those with access to a school's health information system may include staff in the school nurse's office, other health professionals at the school, and management information system staff. There should be a clear understanding of who has access to what information. Staff who have been authorized to access only school administrative data should not be given access to that portion of the system that contains health data. All staff with access to computers containing school health data should have on file with their employer a signed Information Security Acknowledgement Form which clearly describes the security rules and protocols. Supervisors should review the information on the form with staff to promote a clear understanding of expectations. By signing the form, staff agree to adhere to the rules and protocols. vi) Data Reporting Publications of the data should appear only in aggregate, so that data cannot be linked to individual subjects. Suppression rules should be employed which do not allow the reporting of any data cells with less than five cases. vii) Centralized Data System Security Features If situations arise in which districts transfer raw (individual-level) data from local school buildings to a district-wide and/or statewide database, additional security precautions must be observed.3 We describe these special security procedures below so that those districts or states that choose to develop central repositories for their data will be aware of relevant procedures. The following procedures promote safe data transmission. When using the U.S. Postal Service to transmit data disks or documents: • The name of the specific individual to whom the data is mailed should be clearly marked on the item. • The item should be labeled confidential, only to be opened by an authorized person. • Sturdy envelopes should be used to minimize the risk of accidental tearing. • If disks are mailed to the Central Repository, they should be placed in special mailing envelopes designed for disks. • All data submitted should be encrypted prior to transmission to the central repository. • Submission by mail or electronic file transfer should be communicated by telephone so that the recipient is looking out for the package. 3 Such data transfer has both advantages and disadvantages. Districts or states that choose to utilize this type of data transfer do so in order to analyze their data more completely and to become more informed about the health needs of school-age children in their jurisdiction. However, concerns about the confidentiality of student health records are heightened when records are housed in a central repository rather than remaining dispersed at the local level. 10
  • 14. Data transfer via unencrypted e-mail over the Internet is NOT recommended for individual-level records or any sensitive information. When transferring data electronically via secure channels on the Internet or other enclosed networks, guidelines should be established regarding how to encrypt data prior to transmission, through what secure channel data will be transferred, and who will be receiving the data. The following steps to ensure security at the central data repository should be taken in addition to those already put in place at individual school buildings. • If a network is not being used for data collection or data integration, then the central database should reside on a stand-alone computer system, not network-accessible. • The computer system should be physically located in an office that can be locked. • Data is encrypted using a key that is known only by appropriate authorized personnel. • Access to the central database is controlled through passwords. • No names or other directly identifying information should be stored as part of the central database. In Massachusetts, the standard for submitting data to the state requires that no identifying information be included once the data leaves the local school system. Over time, a numeric permanent student identifier (PSID), which allows for linking multiple records for a single student, would dramatically increase the depth of data analysis possible. If a PSID system is adopted, policies and procedures should be defined covering how identifiers are assigned and how they follow the student across transfers within and between school systems. In order to breach security and obtain identifiable data, a person would have to gain physical access to the Central Repository computer, decrypt the database or log on to the database with a valid user ID and password, and be able to identify individual data, despite the absence of identifying fields. Such a sequence of safeguard violations would be rare. Nonetheless, even though no identifying data is being stored in the Central Repository, there is some risk that anonymous data could be associated with an individual. The primary risk points are the date-of-birth and the school building codes. The following steps could be taken to remove even this low level of risk. The date-of-birth and date-of-measurement could be removed from the Central Repository as data is loaded into it, and replaced with a field containing age at measurement. Standard school building and/or school district codes could be replaced by private MIS codes, with the correspondence kept in a secure fashion, outside of the Central Repository database. Because there can be threats to confidentiality within each step from data collection to transmission, analysis, and reporting, rules should be developed for each point. Similar to the procedures recommended for local schools, only staff authorized to utilize or handle the data should be permitted access to the Central Repository. All employees should be trained on standard procedures to maintain confidentiality. New employees should be trained in procedures as part of their initial training. Annual refresher sessions should be held for all staff. 11
  • 15. 3. CONSIDERATIONS FOR SELECTING A SOFTWARE PACKAGE Based upon our experience in Massachusetts, there are many considerations to take into account when purchasing school health software, including suitability of the system design, costs (of software, installation, training, and maintenance), ease of use, functional capabilities, and Year 2000 compliance. A. Suitability of System Design i) Stand-alone versus Modular Health Software A major distinction can be made between 1) specialized, stand-alone school health software, and 2) school health modules designed to be integrated into, and function with, a school’s administrative software package (which may keep records of grades, attendance, and discipline, as well as perform functions like class scheduling). Specialized school health software packages typically are designed to be used on a single personal computer, although many now can be networked to some extent – used by multiple users in a school or district. Software modules, on the other hand, generally are designed to work with the school administrative software package published by the same vendor. While some of these modular applications do work on a single personal computer or on a single school network, in many cases they are used on a district- wide network, with a central server (on which the database application and the data reside) connected to networked personal computers at each school building. ii) Integrated versus Non-integrated Databases Another important issue is the location of the database in the district. Here, one can distinguish between 1) multiple, non-integrated databases, 2) distributed databases, and 3) centralized database configurations. With multiple non-integrated databases, there is a separate database located at each school building, which contains only records for students attending that school, and which does not have the capability to be automatically linked to a central database. In a distributed database configuration, there is a separate database at each school, but all the separate databases have the capability to be synchronized with a central district-wide database so that an integrated database can be created. In a centralized database, a single master database containing all district records resides in a central district location. The key issue is that the second two configurations allow for an integrated district-wide database, while the first configuration does not. Many school health software applications were originally designed to be used at only one school building (and not integrated with databases used at other schools in the same district), in part because computers used by school nurses have historically not been connected to a district network. This approach is also simpler and less costly than other configurations. However, creating some type of centralized or distributed district-wide database makes it much easier to perform database administration and data management tasks; transferring records when students 12
  • 16. transfer between schools is simplified; changing menu items in drop-down lists can be done centrally to ensure district-wide data consistency; providing passwords and implementing security features for regular and substitute nurses can be handled centrally; producing district-wide data reports and analyses is greatly facilitated; and backup procedures can be performed in a more consistent and uniform fashion by skilled technical personnel. If multiple non-synchronized databases are used across a district, the routine transfer of records from one school to another would require staff members to perform time-consuming manual data extractions and insertions. Furthermore, if there is no provision for the automatic aggregation of data stored at each school, then producing simple district-wide reports in order to meet state requirements would require that the same reports be run at each school, and then manually combined to produce district totals. This duplication of effort is highly inefficient. Alternatively, the records at each school could be manually extracted and then imported into an aggregate database for running reports. This “manual extract” process is only slightly more efficient. Fortunately, many school health applications now have some provision for automatically aggregating data across the district on a regular basis (perhaps once per day) using modems or the district network to connect the separate databases to an integrated district database. However, this often requires the purchase of a separate “district integrator” module as well as computer modems (for those not on a district network). In addition, in very large districts, file synchronization may become a slow and cumbersome process. Some software packages can be used in a variety of different network configurations, while others have very specific requirements. The district’s MIS personnel and the software vendors’ staff can help determine which software applications are appropriate for the type of network in your district. iii) Web-enabled Applications Vendors of school health software are also beginning to offer web-enabled versions of their product for use on intranets, which are private versions of the internet that limit access to authorized users. Like traditional centralized applications described above, web-enabled software stores data in a central location so that the database is always up-to-date, recording changes is relatively easy when a student transfers between schools in the same district, and creating district data reports is much simpler. In addition, web-enabled versions of school software provide the following advantages: they are platform independent (i.e., it can be used by either a Microsoft Windows personal computer or a Macintosh running Netscape Navigator or Microsoft Internet Explorer); they may be made accessible off-site (from either home or school, depending on the firewall setup); they are easily scalable to large numbers of users, and (according to one vendor) they require less bandwidth than some conventional client/server systems. 13
  • 17. Given the growth of interest in web applications and the increasing number of schools with high-speed internet connections, it would not be surprising to see more vendors begin to offer similar products. However, web-enabled applications can be expensive, requiring either that the district set up their own web server, high-speed network connection, pay database licensing fees, and hire a skilled database administrator, or that the district pay someone else for these services. In addition, both networks and the required servers are susceptible to traffic overloads, and response time may be disappointing unless each nurse’s workstation has a relatively new processor, ample RAM memory (48 MB or more), and a 56K modem with a dedicated telephone line or (even better) access to a high-speed network connection (such as a T-1 line) through a school network. iv) Considerations For Choosing a System Design The choice between specialized and modular software involves a variety of tradeoffs. The modular approach provides easier data integration between health and administrative records and allows MIS staff to focus their resources on supporting a single unified system. These systems can be offered with a wide variety of administrative modules. Some software vendors offer only a few modules, while others provide a quite extensive selection. Districts may want to investigate which software vendors offer the specific types of modules that best meet the broader information systems needs of the district. Modular systems are typically designed around larger-capacity databases capable of supporting more concurrent users, which may be important in districts in which administrative and health users are accessing the same database. However, modular systems are also more difficult and more costly to install and maintain, may require a longer learning period, a greater level of systems and networking support, and a greater initial investment. In addition, while many administrative packages have broad administrative functions they may not offer all the specific health-related functionality of specialized school health software. Finally, many modular packages have harder-to-use user interfaces than specialized school health software, and may be slow if used over district-wide networks. Specialized school health software packages tend to require a less costly initial investment, tend to be easier to install and use, usually provide for fast access to data (because it is locally stored), and have more health-related functionality. However, several popular specialized school health software packages are actually built from a Microsoft Access database, which, even on high speed networks, typically cannot support more than 20 or 30 simultaneous users.4 In addition, creating links between school health data and school administrative databases is more difficult with specialized school health software, generally requiring manual importing and exporting of student demographics data on a regular basis (once per year, for example). 4 The printed and on-line documentation that comes with Microsoft Access indicates that up to 255 users on a network can open an Access database. However, this figure only represents the number of users who can have the database open, not the number of users who can actually use the database productively to update data and run queries. There is no single number for this, because the maximum number of users depends on the database design and the frequency with which users update and access data. According to one Microsoft publication, an Access database can only support “up to 20 simultaneous users” (Viescas, 1999). Yet another authority suggests that in many cases even this number is too high: “ . . . More than 10 users concurrently accessing an Access database can really degrade performance” (Balter, 1997). A knowledgeable representative for a popular Access-based school health software package indicated in a 1999 telephone conversation with one of the authors of this report that their system slows to unacceptable levels at around 30 users. 14
  • 18. Some specialized software vendors are taking steps to make up for these shortcomings, however. Some software vendors may develop versions of their software that are built upon larger capacity databases that can be used over a district’s wide-area-network, and the growth of distributed database configurations makes the limitations on simultaneous users irrelevant because the data can be synchronized across a district without using a single database. In addition, some specialized software vendors have formed partnerships with providers of school software application “suites,” with built-in links to share common demographic data, thus providing some of the added functionality of modular software. Small school districts with smaller MIS infrastructures and fewer MIS support staff will usually find that specialized school health software applications best meet their needs. Larger school districts can choose either specialized school health software or school health modules. However, because of the volume of data involved, it will be even more important for them to choose an application that provides some way of integrating district-wide school health data. In the largest districts or regions, the scalability offered by web applications is an advantage. In practice, many districts are already using an administrative software package. In these cases, the school health module published by the same vendor and which “plugs into” the existing administrative system is a logical choice, despite the disadvantages of modular systems mentioned above. In Massachusetts, we have noticed that some school districts that started out using specialized school health software have decided to transition to school health modules that work with the administrative software package used by the district. B. Costs Software costs are typically based on the number of schools or the number of nurses who will be using the software. Volume discounts are frequently available, and, in some cases, district licenses are available instead of single-site or single-user licenses. Some vendors require only a one-time license fee, while other vendors require an annual license fee every year of use, with possible discounts after the first year. Some software vendors may offer older versions of their software at substantial discounts, although districts should be especially careful to check for Year 2000 compliance before considering these. Stand-alone school health software packages are typically less costly than health software modules that integrate into school administrative packages because the former costs less to license, install, and maintain. However, costs for health modules are more difficult to define. These software packages may require a quote from the vendor, and will likely depend on not only the size of the district but also the installation, technical support, upgrade, and customization needs of the district. Customization of the software, either upon installation or to meet the changing needs of the district over time, may add significant cost. Because the cost structure of school health software packages varies widely and changes frequently, districts should obtain the latest pricing information for the software packages that they are considering. 15
  • 19. In addition to the cost of the software itself, other costs that districts may need to consider include hardware costs (including workstations and the server, if required), networking hardware and installation (if required), end-user training, annual technical support fees (both in-house and vendor-supplied), network maintenance support, and the additional clerical and other personnel that may be needed for data entry, data checking, and data compilation and analysis. C. Ease of Use Differences in the design of the graphical user interface may significantly affect ease and speed of use in busy nurses’ offices. This can greatly affect nurses’ level of satisfaction with the product and motivation to use the software. With some software packages it is easy to perform data entry as patients are seen; while with others the user interface is so hard to use that nurses find it easier to make paper notes and then do data entry at the end of the day. This may require hiring additional clerical and nursing staff, increasing the effective cost of using the system. In addition, a good, intuitive design that is visually appealing, that requires few mouse clicks, and that has fast screen redraws can greatly reduce learning time and increase user satisfaction. D. Functional Capabilities Common functional capabilities include the ability to maintain daily logs of health encounters, to keep and access individual student records, to maintain immunization records, to record health screenings, and to create basic reports. Software should be capable of logging all health services activities and encounters involving both students and staff. The software should also be able to track and maintain health records concerning medications, immunizations, injuries, medical procedures, health screenings, and mental health counseling. Software packages provide a variety of ways of recording specific types of health activities and entering health records. School districts should look for systems that are easy to use (utilizing drop-down lists, for example, increases speed and minimizes typing errors) and can be customized to meet changing local needs. The capacity to maintain a wide variety of health-related records including data on student demographics, health insurance providers, primary care providers, and emergency contacts is also useful. School health software should also be capable of developing both standard and customized reports on the population served at the local level. Other less-common functional capabilities that may be offered include built-in validity checks to assure data integrity, the ability to provide graphical reports, and appointment scheduling. School districts that are evaluating software should be aware of the wide variety of functional capabilities that are available. The next section provides a listing of common features and functions that are available in school health software packages; this information is provided in tabular form to help school districts compare and contrast these packages. 16
  • 20. E. Year 2000 Compliance Many software packages, including school health software, were not designed to correctly handle dates after the Year 2000. School health software uses dates in a variety of ways, including daily logs, appointment scheduling, immunization history, and data reporting. Therefore, it is essential that any software package that school districts use for recording school health data be Year 2000-compliant, and that districts using older versions obtain a Year 2000- compliant upgrade. School districts should ask vendors whether the software they are using or are considering purchasing is Year 2000-compliant. 17
  • 21. 4. SOFTWARE COMPARISON Specialized school health software applications and school administrative applications with significant health functionality are listed in the tables on the following pages.5 The eight tables include the following types of information: 1. Vendor contact information: includes addresses, phone numbers, and web sites. We also list which vendors have created demo disks, and whether they are “fully functional” evaluation versions or simply “slide shows” that show what the application screens look like. 2. Software pricing and licensing: describes initial product purchase costs, the pricing structure, annual fees, and support fees. 3. Software and hardware requirements: describes the minimum computer configurations needed to run the software and also identifies which packages run on Windows personal computers and which run on Macintosh computers. 4. Systems design, security and on-line help: each package is identified as either 1) specialized school health software or 2) a health module that works with a general school administrative software package. District-wide database integration capabilities are also described. We also distinguish between single and multi-level password systems, and identify those applications with on-line help. 5. Types of data screens available: describes the types of data entry screens and logs that are available for entering and reviewing data (i.e., individual student records, daily logs, activity logs, inventory logs, medication administration logs). 6. Individual student record elements available: describes what features are available as part of the individual student record such as dental records, individual health care plans, family history, emergency contact information, etc. 7. Reports and other available functions: additional features provided by each software, such as the ability to generate reports and lists, to automated screening and referral tracking. 8. Data management capabilities: comparison of data manipulation functions. 5 The information in these tables has been confirmed as accurate by the software vendors as of June, 1999. Since software is constantly being enhanced and pricing changes, school districts should use this information as a starting point for further exploration and always obtain updated information before making software purchase decisions. 18
  • 22. VENDOR CONTACT INFORMATION SOFTWARE SOFTWARE PHONE WEB SITE ADDRESS TITLE VENDOR FAX DEMO DISK National Center www.uchsc.edu/fusion/ 1056 E. 19th Ave. B516 Clinical Fusion for School- (303) 764-8400 index.htm Based Health (303) 837-2962 Yes. Slide Show. Denver, CO 80218 Info. Systems Patient Medical www.pmrinc.com 901 Tohoka Road Dyn-O-Mite & Dyn-O-Log Records, Inc. (800) 285-7627 (806) 637-4283 Yes. Functional. Brownfield, TX 79316 Eagle Software www.eagle2000.com 17821 Seventeenth St. EASY-99 (888) 324-5363 Yes. Functional. Tustin, CA 92780 Tools for www.w3.ime.net/ RR1 Box 2319 Educational Caregiver Teachers (207) 324-1732 ~deceiver/nurse1. Html Yes. Functional. Sanford, ME 04073 EDUNET, www.edunet4.com 250 Mt. Lebanon Blvd., Ste. EDUNET Student Incorporated (412) 344-3390 417 Database System (412) 344-3413 Yes. Available Nov. Pittsburg, PA 01534 1999. Healthmaster, www.healthmaster.com 3162 Martin Road HealthOffice 2000 Inc. (888) 714-1400 (248) 960-8908 Yes. Functional and Walled Lake, MI 48390-1627 Slide Show. Computer www.cri.mms.com 94 Route 125, P. O. Box 60 Modular Management Resources (603) 664-5811 System (MMS 2000) Incorporated (602) 664-5864 Yes. Functional. Barrington, NH 03825 Nordex www.nordexinter 185 Lincoln St. Suite 220 Nordex School International Inc. (781) 740-4506 national.com (781) 740-1025 None. Hingham, MA 02043 Pentamation www.pentamation.com 225 Marketplace Pentamation Open Education (610) 691-3616 Series Systems Division (610) 691-1031 None. Bethehem, PA 18018 NCS Educational k12.ncs.com/k12/ 170 Colonel Lovell's Lane, School Administration Software and (781) 337-5454 school/sasi2.html Townhouse 1 Student Information Services Division (781) 337-4320 Yes. Slide Show. Weymouth, MA 02189 (SASIxp) National Center N/A 1056 E. 19th Ave. B516 School Health Care- for School- (303) 764-8400 Online 4.01 Based Health (303) 837-2962 Yes. Slide Show. Denver, CO 80218 Info. Systems Table 1- Page 1
  • 23. VENDOR CONTACT INFORMATION SOFTWARE SOFTWARE PHONE WEB SITE ADDRESS TITLE VENDOR FAX DEMO DISK Professional www.school-nurse- 77 Wheeler Rd. School Nurse Assistant Software for (800) 889-7627 software.com Program (SNAP98, Nurses, Inc. (603) 465-3465 Yes. Slide Show. Hollis NH 03049 MacSNAP) Specialized Data www. specdatasys.com 855 W. Prairie School Office Systems (800) 323-1605 (603) 462-1299 Yes. Slide Show. Wheaton, IL 60187 Olympia www.schoolmaster.com 7249 Capitol Boulevard South Schoolmaster Computing (360) 352-0922 Company, Inc. (360) 352-0957 Yes. Functional. Tumwater, WA 98501-5519 Skyward, Inc. www.skyward.com 5233 Coye Dr. Skyward Student (800) 236-7274 Management Software None. Stevens Point, WI 54481 Century www.centuryltd.com 300 Main St. Star_Base Consultants (732) 363-9300 (732) 363-9374 None. Lakewood, N.J. 08701 Expert Computer www.ecisw.com 24 West Main St., Suite 15 Student Health Manager Integrators (515) 753-6676 3.53 (515) 753-3771 Yes. Functional and Marshalltown, IA 50158 Slide Show. Management www.mig.ab.ca 1756 E. Greenway Rd., Ste. 2 Student Information Information (602) 951-0211 Record System Group None. Scottsdale, AZ 85260 TREVLAC www.trevlac.com P.O. Box 1120 45 Ontario St. The School Computer (800) 363-3633 Administrator (Version Services Ltd. (519) 238-6770 None. Grand Bend, Ontario, Canada 7.0) Center for www.welligent.org 905 Redgate Ave. Suite 102 Welligent Pediatriatric (757) 668-6500 Research + (757) 668-6575 None. Norfolk, VA 23507 others Chancery www.chancery.com Suite 275 -3001 Wayburn Win School, Mac School Software Ltd (800) 999-9931 Drive (604) 294-1233 None. Burnaby, BC V5G 4W1, Canada Table 1- Page 2
  • 24. SOFTWARE PRICING AND LICENSING SOFTWARE PRICE FOR FIRST PRICE FOR EACH PRICE FOR DISTRICT TITLE SCHOOL* ADDITIONAL TECHNICAL LICENSE SCHOOL* ASSISTANCE* Clinical Fusion Single user: $750 + $150 Discount of 10% -30% Fee-based phone support No required annual fee. off the $750 price. ($150 per year), includes Network: add $250 per PC Annual fees additional. unrestricted phone + annual fee of $45. assistance. Dyn-O-Mite & Dyn- $599 for Dyn-O-Mite; $399 $499-$599 (Dyn-O- Price includes 60 days No. O-Log for Dyn-O-Log. Priced per Mite); $299-$399 (Dyn- phone support. Email concurrent user. O-Log). Or, add support always free. $100/school if only $159 - $189 per user per using 1 PC. year for toll phone support. EASY-99 $5,000 (elementary) - $5,000 (elementary) - Fee-based toll-free phone No $10,000 (high schools) $10,000 (high schools) support: $1000 - $2,000 for first year. Educational $79.00 $189.00 for 3 users; Free E-mail assistance. Yes. Caregiver $276.00 for 5 users $399 (unlimited use) EDUNET Student $4,900 (required base Same as for first 90-day toll-free phone No Database System package) + $3,850 school. Call for support included. Annual (medical records module). additional information. maintenance fee @ 18% of license fee (optional). HealthOffice 2000 $800 per concurrent user, $800 per concurrent Price includes 1 year No 1-time license fee (up to user (750 students). phone support. $150/year 750 students). $125 (@ Optional database for thereafter (optional). 250 additional students). merging district data: Training: $900/day + travel $990. expenses. Modular $3,900 (for base system + Roughly 10% discount Several fee-based support No Management health module). $400 from price for first & upgrade plans are System (MMS extra for Massachusetts school. Free software available (including phone, 2000) DOE SIMS compliant for district central office. e-mail, and remote control module. support). Nordex School Required base module: Same as for first Fee-based phone support. No. $1,600 (single-user), school. District-wide On-site training available. $2,400 (multi-user); data integrator: add Health: add $1,280 (single- $8,080. user). Other packages Note: Price estimates are provided by the software vendor and are subject to change. Table 2- Page 1
  • 25. SOFTWARE PRICING AND LICENSING SOFTWARE PRICE FOR FIRST PRICE FOR EACH PRICE FOR DISTRICT TITLE SCHOOL* ADDITIONAL TECHNICAL LICENSE SCHOOL* ASSISTANCE* Pentamation Call for information Call for information Fee-based. Installation, Call for Open Series training, phone support, info. and on-line problem diagnosis. School Call for information Call for information. Fee-based toll-free phone No Administration support, internet links, and Student fax support service. Information (SASIxp) School Health Call for information Call for information Fee-based phone support. Yes Care-Online 4.01 School Nurse $699 (Single user $649.00 (Single user Price includes 1 year of No Assistant Program license). $799 (multiple license). $249/school phone support. $110 to (SNAP98, user license). and $150/user (multiple $350 per year thereafter. MacSNAP) user / network license). School Office $1,700 per district Discounts negotiable. Fee-based toll-free phone Yes (standalone health and internet support. module). $14,000 (complete package). Schoolmaster $2,500 - $5,800, Same as for first school. Purchase price includes 5- No. depending on enrollment & 8 hrs. training & support via grade level. Annual toll-free phone. license fee: $500-$800 after first year. Skyward Student Call for information Call for information Toll-free phone support. Yes Management Software Star_Base Software: $10 per Same as for first school. Fee-based toll-free phone No student. Annual fee: support. On-site training approx. 20% of software workshop available. fee. Annual fee approx. 20% of license fee. Note: Price estimates are provided by the software vendor and are subject to change. Table 2- Page 2
  • 26. SOFTWARE PRICING AND LICENSING SOFTWARE PRICE FOR FIRST PRICE FOR EACH PRICE FOR DISTRICT TITLE SCHOOL* ADDITIONAL TECHNICAL LICENSE SCHOOL* ASSISTANCE* Student Health $550 per building (single- $100.00 Fee-based support and No Manager 3.53 user or network) program enhancements: $200 for 1st school, $75 each additional. Student Call for information Call for information Fee-based support Call for Information contracts are required of all info. Record System users. The School $750 (Basic Program; District discount pricing Toll-free phone support is Call for Administrator includes health data) is available. free first year, $250 info. (Version 7.0) thereafter. Training $500/day + expenses. Welligent $1,250 (1st year). Annual $1,250 per school or Annual license fee No license fee after year 1: per user (plus same includes phone and email 25% of initial price if district annual license fees as support. On-site training hosts web site, 50% if for initial school). $650/day + expenses. Welligent hosts. Win School, Mac $2,500 per site (core Same as for each Fee-based phone support No. School database + health school (volume and internet support. module), up to $8,000 for discounts available). all components. Note: Price estimates are provided by the software vendor and are subject to change. Table 2- Page 3
  • 27. SOFTWARE and HARDWARE REQUIREMENTS SOFTWARE MINIMAL COMPUTER OPERATING NETWORKABLE TITLE HARDWARE NEEDS SYSTEM Clinical PC: Pentium 233, 64 MB RAM, 2GB hard drive, Windows 95, 98, Yes. Fusion CD-ROM, laser printer. NT. Dyn-O-Mite & PC: 386 or higher processor. PC: MS DOS or Yes. Dyn-O-Log Mac: 68020 and higher processor, 8MB RAM, Windows 3.x and hard drive. higher. Mac: System 7 and higher. EASY-99 PC: Pentium II, 32 MB RAM. Windows 3.1, 95, Yes. 98, NT. Educational A Mac capable of running Filemaker Pro 3.0 or Mac: Mac OS and Yes. Caregiver greater. A Windows version is planned. Filemaker Pro 3.0 or greater. Soon available for Windows. EDUNET PC: Pentium 120 MHz, 32 MB RAM (for Windows 95, 98, Yes. Student Windows version) NT. Database System HealthOffice PC: Pentium 166 MHz (300 MHz Windows 95, 98, Yes. 2000 recommended), 24 MB RAM (64 MB NT 4.0. recommended), 100+ MB free space on hard drive, CD-ROM drive. Modular PC: Pentium II 100, 32 MB, 4 GB hd drive. Windows and Yes. Management PC Server: Pentium II, 64 MB, 6 GB hd drive. Mac. Mixed System Mac: PowerPC 604e, 32 MB RAM, 4 GB hd PC/Mac (MMS 2000) drive. environment Mac Server: PowerPC 604e, 64MB RAM, 4 supported. GB hd drive. Table 3 - Page 1
  • 28. SOFTWARE and HARDWARE REQUIREMENTS SOFTWARE MINIMAL COMPUTER OPERATING NETWORKABLE TITLE HARDWARE NEEDS SYSTEM Nordex PC: Pentium or Pentium II processor, 16MB Windows 3.x, 95, Yes. School RAM, 25 MB hard drive. NT. Mac: PowerPC processor, 16MB RAM, 25 MB Mac: OS 8.1. hard drive. Server: Novell, Server: 100MB HD. Windows NT, Unix. Pentamation Any combination of PCs and Macs. Workstations: Yes. Open Series Server running UNIX, NT, Novell; or an Intranet. Windows or Mac OS. Server: UNIX, NT, or Novell. School PC: 486/66, 12MB RAM, 80MB HD. PC: Windows 95. Yes. Administration Mac: 68040/33, 12 MB RAM, 80 MB HD. Mac: System 7.5. Student Server: Pentium 133, NetWare 4.x or NT, 48 MB Mixed PC/Mac Information RAM + 1MB for each user above 20, 300MB+ environment (SASIxp) HD. Ethernet or token ring adapter. supported. School PC: 486 processor recommended, 4-8 MB MS DOS and Yes. Health Care- RAM, 60+ MB hard drive . higher. Online 4.01 School Nurse PC: Pentium 166 MHz (minimum), PII 266 Windows 95 or Yes. Assistant (recommended), 32 MB RAM, CD ROM. Mac. Program Mac: 68040, 8MB RAM (minimum); 100 MHz (SNAP98, PowerPC, 24 MB RAM(recommended). MacSNAP) School Office PC: Pentium 75 MHz, 16 MB RAM (depending Windows 3.x, 95, Yes. on size of database and number of users). NT. Schoolmaster PC: Pentium 90+ MHz, 32 MB RAM, CD-ROM. Windows 3.1, 95, Yes. Mac: G3 processor 98, NT. Dedicated file server (only needed for multi-user systems): Pentium 100 MHz with 64 MB RAM, Mac: OS 8.1 minimum, or G3 processor with 128 MB RAM and AppleShare IP 6.1 Table 3 - Page 2
  • 29. SOFTWARE and HARDWARE REQUIREMENTS SOFTWARE MINIMAL COMPUTER OPERATING NETWORKABLE TITLE HARDWARE NEEDS SYSTEM Skyward PC: Pentium II 350 MHz, 64 MB RAM, 6 GB Windows 95, 98, Yes. Student HD, 24x CD-Rom. NT 4.0. Management NT Server: PII 450, 256 MB RAM, SCSI drive. Mac OS. Software Star_Base PC: 32 MB RAM. Windows 95, NT. Yes. Mac: G3 processor, Virtual PC software. Server: UNIX Centralized server. Student Mac: 68030 or faster, 8MB RAM. IBM: Windows Yes. Health PC: 486 +, 16 MB RAM (8 MB w/Windows 3.1). 3.1, 95, or NT. Manager 3.53 Dedicated database server recommended for Mac: Sytem 7.2. large installations. Mixed PC/Mac environment supported. Student PC: Pentium 75 MHz, 16 MB RAM. Windows 95, 98 Yes. Information Local area network. Record System The School PC: Pentium (any), 16 MB RAM, 50MB HD. Windows 95, 98, Yes. Administrator Mac: G3 processor, Virtual PC software. NT. (Version 7.0) Web access through Macs available. Welligent PC: Pentium 200+, 48 MB RAM, 30 MB HD Client: Windows or Yes. Mac: PowerPC, 48 MB RAM, 30 MB HD Mac OS. Network connection: 56 K modem, dedicated Servers: UNIX or phone line, or high-speed connection. Web Windows NT application and database servers (or use of running Oracle. Welligent servers). Win School, PC: Pentium 166+, 32 MB RAM. Windows 95 and Yes. Mac School Mac: 68040 +, 16 MB RAM. Mac OS 7. Table 3 - Page 3
  • 30. SYSTEM DESIGN SECURITY & HELP SOFTWARE DATABASE FUNCTIONAL TYPE OF PASSWORD ONLINE TITLE & DESIGN FEATURES DISTRICT-WIDE DATA SECURITY HELP INTEGRATION Clinical Fusion Specialized health software for Multiple non-integrated Multi-level. Yes schools and community clinics. databases. No automatic Based on Microsoft Access. centralized data aggregation. Dyn-O-Mite & Specialized school health software. Multiple non-integrated Single-level. Yes Dyn-O-Log Dyn-O-Mite is for immunizations & databases. No automatic screenings; Dyn-O-Log is for daily centralized data logs. Version 99 is based on Foxpro aggregation. (ODBC compliant). Upgraded version planned. EASY-99 School administrative software. Multiple non-integrated Single-level Yes Based on Microsoft Access. Limited databases. No automatic health functionality. centralized data aggregation. Educational Specialized school health software. Multiple non-integrated No Yes Caregiver Based on Macintosh Filemaker Pro databases. No automatic information database. Windows version in centralized data available. development. aggregation. EDUNET School administrative software. Multiple non-integrated Multi-level. Yes Student Health module available. Based on databases. No automatic Database Microsoft Access database. New centralized data System Windows version available Fall 1999. aggregation. HealthOffice Specialized school health software. Distributed database. Multi-level. Yes. 2000 Based on Microsoft Access. A Automatic centralized more costly version based on a data aggregation module larger-scale database is under (optional). development. Modular School administrative software. Multiple non-integrated Multi-level. Yes Management Health module available. Based on databases. No automatic System (MMS FoxPro database. centralized data 2000) aggregation. Table 4 - Page 1
  • 31. SYSTEM DESIGN SECURITY & HELP SOFTWARE DATABASE FUNCTIONAL TYPE OF PASSWORD ONLINE TITLE & DESIGN FEATURES DISTRICT-WIDE DATA SECURITY HELP INTEGRATION Nordex School School administrative software. Distributed database. Multi-level Yes Based on FoxPro database. SQL Automatic centralized Server and Oracle versions under data aggregation development. (optional). Slower centralized capability. Pentamation School administrative software. Centralized or distributed Multi-level. Yes Open Series Based upon ODBC compliant 4GL (with automatic database. Web-based reporting centralized data option. aggregation). School School administrative software. Distributed database. Multi-level. Yes Administration Health functions included in the Automatic centralized Student basic package; other modules data aggregation module Information available. (optional). (SASIxp) School Health Specialized school health software. Multiple non-integrated Multi-level. Yes Care-Online 4.01 databases. No automatic centralized data aggregation. School Nurse Specialized school health software. Multiple non-integrated Multi-level. Yes Assistant Based on Microsoft Access databases. No automatic (6 levels). Program database. centralized data (SNAP98, aggregation. MacSNAP) School Office School administrative software. Distributed database. Single-level. Yes Health module available either stand- Automatic centralized alone or integrated into a complete data aggregation module package. (optional). Schoolmaster School administrative software. Distributed database. Multi-level. Yes Health component included in the Automatic centralized basic package. Uses a proprietary data aggregation database w/ built-in data export. (optional). Table 4 - Page 2
  • 32. SYSTEM DESIGN SECURITY & HELP SOFTWARE DATABASE FUNCTIONAL TYPE OF PASSWORD ONLINE TITLE & DESIGN FEATURES DISTRICT-WIDE DATA SECURITY HELP INTEGRATION Skyward Student School administrative software. Centralized database. Multi-level Yes Management Software Star_Base School administrative software. Centralized database. Single-level Yes. Health module available. Based on Web version planned. Oracle database. Web-enabled version planned. Student Health Specialized school health software. Centralized or multiple Single level. Yes Manager 3.53 Based on FileMaker Pro database. non-integrated (no FileMaker Pro Server (for optional automatic data client/server setup). aggregation.) configurations. Student School administrative software. Centralized database. Multi-level Yes Information Based on the FoxPro database. Record System Unlimited concurrent users. Includes health component. The School School administrative software. Centralized (client/server Multi-level Yes Administrator Health included in Basic module. or web) or distributed (Version 7.0) Uses Visual FoxPro database; can (w/automatic centralized also be used in client/server mode data aggregation) with Oracle or SQL Server. Web- configurations. enabled feature available. Welligent Specialized school health web Centralized database. Single-level Yes application. 3-tier architecture Only available as a Web based on an Oracle database. application. Intra/internet use only. Win School, Mac School administrative software. Centralized ("Open Multi-level. Yes School Proprietary database. Oracle & SQL District") or distributed Server options. ODBC connectivity (with automatic data and web access available for real- aggregation, "District time district data module ("Open Integrator" module). District"). Table 4 - Page 3
  • 33. TYPES OF DATA SCREENS AVAILABLE INDIVIDUAL MEDICATION INVENTORY STUDENT DAILY SOFTWARE STUDENT LOG LOG ACTIVITY LOG TITLE RECORD RECORD Clinical Fusion Yes Yes Yes Yes Yes Dyn-O-Mite & Dyn-O-Log Yes Yes Yes Yes Yes EASY-99 Yes No No Yes No Educational Caregiver Yes Yes Yes Yes Yes EDUNET Student Database Yes Yes Yes Yes Yes System HealthOffice 2000 Yes Yes Yes Yes Yes Modular Management System Yes Yes Yes Yes Yes (MMS 2000) Nordex School Yes Yes Yes Yes Yes Pentamation Open Series Yes Yes Yes Yes Yes School Administration Student Yes Yes Yes Yes Yes Information (SASIxp) School Health Care-Online Yes Yes Yes Yes Yes 4.01 School Nurse Assistant Yes Yes Yes Yes Yes Program (SNAP98, MacSNAP) School Office Yes Yes Yes Yes Yes Schoolmaster Yes Yes Yes Yes Yes Skyward Student Management Yes Yes Yes Yes Yes Software Star_Base Yes Yes Yes Yes Yes Student Health Manager 3.53 Yes Yes Yes Yes Yes Student Information Record Yes Yes Yes Yes Yes System The School Administrator Yes Yes Yes Yes Yes (Version 7.0) Welligent Yes Yes Yes Yes Yes Win School, Mac School Yes Yes Yes Yes Yes Table 5- Page 1
  • 34. INDIVIDUAL STUDENT RECORD ELEMENTS AVAILABLE FAMILY SPECIAL DENTAL HEALTH SOFTWARE HISTORY EMERGENCY RECORDS CARE PLAN TITLE INFO FILES Clinical Fusion Yes Yes Yes Yes Dyn-O-Mite & Dyn-O-Log Yes Yes Yes Yes EASY-99 No No No No Educational Caregiver Yes Yes Yes Yes EDUNET Student Database Yes Yes No Yes System HealthOffice 2000 Yes Yes Yes Yes Modular Management System Yes Yes Yes Yes (MMS 2000) Nordex School Yes Yes Yes Yes Pentamation Open Series Yes Yes Yes Yes School Administration Student Yes Yes Yes Yes Information (SASIxp) School Health Care-Online 4.01 Yes Yes Yes Yes School Nurse Assistant Yes Yes Yes Yes Program (SNAP98, MacSNAP) School Office Yes Yes Yes Yes Schoolmaster Yes Yes No Yes Skyward Student Management Yes Yes Yes Yes Software Star_Base Yes Yes Yes Yes Student Health Manager 3.53 Yes Yes Yes Yes Student Information Record Yes Yes Yes Yes System The School Administrator Yes Yes No Yes (Version 7.0) Welligent Yes Yes Yes Yes Win School, Mac School Yes Yes Yes Yes Table 6 - Page 1
  • 35. REPORTS AND OTHER AVAILABLE FUNCTIONS CREATE INJURY RECORD AUTOMATIC AGGRE- IMMUNIZA- PRINT SOFTWARE REPORTS REPORT MULTIPLE SCREENING, GATE TION INDIVIDUAL TITLE AND LISTS DIAGNOSES REFERRAL TOTALS REPORT RECORDS TRACKING Clinical Fusion Yes Yes Yes Yes Yes Yes Yes Dyn-O-Mite & Dyn-O- Yes Yes Yes Yes Yes Yes Yes Log EASY-99 Yes No No No No Yes Yes Educational Caregiver Yes Yes Yes Yes Yes Yes Yes EDUNET Student Yes Yes Yes Yes No Yes Yes Database System HealthOffice 2000 Yes Yes Yes Yes Yes. Yes. Yes. Modular Yes Yes Yes Yes Yes Yes Yes Management System Nordex School Yes Yes Yes Yes Yes Yes Yes Pentamation Open Yes No Yes No Yes. Yes. Yes. Series School Administration Yes Yes Yes Yes Yes. Yes. Yes. Student Information School Health Care- Yes Yes Yes Yes Yes Yes Yes Online 4.01 School Nurse Yes Yes Yes Yes Yes Yes Yes Assistant Program School Office Yes Yes Yes Yes Yes Yes Yes Schoolmaster Yes Yes Yes Yes Yes Yes Yes Skyward Student Yes Yes Yes Yes Yes Yes Yes Management Star_Base Yes Yes Yes Yes Yes Yes Yes Student Health Yes Yes Yes Yes Yes Yes Yes Manager 3.53 Student Information Yes Yes Yes Yes Yes Yes Yes Record System The School Yes Yes Yes Yes Yes Yes Yes Administrator Welligent Yes Yes Yes Yes Yes Yes Yes Win School, Mac Yes Yes Yes Yes Yes Yes Yes School Table 7 - Page1
  • 36. DATA MANAGEMENT CAPABILITIES LETTERS MAILING BILLING APPOINT- DATA END OF IMPORT GRAPH CUSTOMIZE SOFTWARE LABELS MENT INTEGRITY YEAR AND DATA FIELDS TITLE SCHEDUL- CHECK PROCESSING EXPORT ING DATA Clinical Fusion Yes Yes Yes Yes Yes Yes Yes Yes Yes Dyn-O-Mite & Dyn- Yes Yes No Yes Yes Yes No Yes Yes O-Log EASY-99 Yes Yes Yes No No Yes No No Yes Educational Yes Yes Yes Yes Yes Yes Yes Yes Yes Caregiver EDUNET Student Yes Yes Yes Yes Yes Yes Yes No Yes Database System HealthOffice 2000 No No Yes Yes Yes Yes Yes No No Modular Yes Yes Yes Yes No No Yes Yes Yes Management Nordex School Yes Yes Yes Yes Yes Yes Yes Yes Yes Pentamation Open Yes No No Yes Yes Yes Yes Yes No Series School Yes Yes Yes Yes Yes Yes Yes Yes Yes Administration School Health Care- Yes No Yes Yes Yes Yes Yes Yes Yes Online 4.01 School Nurse Yes Yes No Yes Yes Yes Yes Yes No Assistant Program School Office Yes Yes Yes Yes Yes Yes Yes No Yes Schoolmaster Yes Yes Yes Yes Yes Yes Yes No Yes Skyward Student Yes No Yes Yes Yes Yes Yes No Yes Management Star_Base Yes Yes Yes Yes Yes Yes Yes Yes Yes Student Health Yes Yes Yes Yes Yes Yes Yes Yes Yes Manager 3.53 Student Information Yes Yes Yes Yes Yes Yes Yes No Yes Record System The School Yes Yes Yes No Yes Yes Yes No Yes Administrator Welligent Yes Yes Yes Yes Yes Yes Yes No No Win School, Mac Yes No Yes Yes Yes Yes Yes No Yes School Table 8 - Page 1
  • 37. GLOSSARY Aggregate Totals: Ability to create reports that aggregate data across classes, schools, districts, or other categories of interest. Appointment Scheduling: Appointment scheduling allows the school nurse to arrange appointments for the student with any nursing staff member Automatic Screening/ An automated tracking system that points out children who are Referral Tracking: behind in their immunizations and other health screenings or reminds the nurse to follow up on a referral. Billing Capacity: The package is able to generate statements for third party billing. Centralized Database: As used in this report, a centralized database refers to a single master database which contains all district records and which resides in a central district location. Although many applications will in theory run on large networks, few are designed to be used over the slow wide-area-networks that most districts use. Child Abuse Records: A record of reports of suspected child abuse. This section of the individual student record is often only accessible through a special password system. Create Reports & Lists: Feature which allows the user to create a list or report based on or aggregated student records. Examples include reports on chicken pox, injuries in specific areas of the school, or a list of the children who are behind in their immunizations. Customize fields: Allows users to add or change data fields or drop-down selection lists to record information in a way that serves local needs. Daily Log: A record of the health encounters and events for each day. Very useful for keeping track of student encounters, and for subsequent data aggregation and analysis. Data Integrity Check: An error-checking feature that works as users enter data to determine if the data meet certain predefined specifications. For example, the program will not allow letters entered where numbers are expected; or it will ask for confirmation if the birth date falls out of an expected range.
  • 38. Demo disk: A free version of the software program that demonstrates the capabilities of the software package to potential users. Some demo disks are fully functional versions of the software which the user can try out for a limited time or with a limited number of records, while others provide a non-functional “slide show” which only illustrates what the software screens look like. Dental Records: The individual student record contains a special section for the student’s dental health record. Design: Primarily refers to the distinction between 1) specialized, stand- alone school health software (with nothing but school health functions) and 2) general school administrative software, usually running on a network, that has an optional school health module. Distributed Database: A system in which there is a separate database at each school in a district, and where all the separate databases have the capability to be automatically linked to or synchronized with a central district- wide database so that an integrated, aggregate database can be created for the district. District License: When payment of a single fee gives the licensee the right to use the software at all schools in the district. End of Year Processing: Moving an entire class of children up a grade and the generation of an end-of-year report as well as many other end-of-year operations are accomplished through use of this option. Family History: A section of the student health record that focuses on family history. Information may include diagnostic categories. Free Text Comment Area: A section of the individual student record that allows for comments in a free text form such as an in depth record of how an injury occurred. Graph Data: The program has the capability to graph data, such as heights and weights. Health Care Plan: A section of the individual student maintains and organizes health care plans designed for children with special health care needs. Health Screening: The individual student record contains a special section for recording the student’s health screenings such as scoliosis, vision, and hearing.
  • 39. Immunization Report: The individual student record contains a special section for recording individual student immunizations and creating immunization reports. This option allows for recording the date the immunization was given. Import and Export Data: Information can be imported into or exported out of the database in a standard format, such as text file, that can be read by other software programs. Individual Student Records: Allows the user to see and access all parts of a student’s record to obtain a comprehensive picture of the student’s health encounters. Injury Reports: A section of the individual student record that focuses on injuries. This may include the type of injury, what the student was doing at the time of the injury and the place where the injury took place. Inventory Log: This log tracks the health unit’s inventory for easy record keeping. Inventory may include anything needed to run the nurses office: bandages and other first aid supplies, blankets or even office supplies. This can be used to track returnables such as crutches or cold packs. Letters: Letters can be created for mass or individual mailings. These letters are based on a pre-designed form or one created by the school nurse. Mailing Labels: Allows printing formatted mailing labels. Medication Log: The medication Log keeps a separate record of the medications being dispensed in the school. Mental Health Records: There is a specific section of the health record that is dedicated to mental health. Minimal Computer Needs: The minimal computer hardware requirements for running the program. Multiple Non-integrated Database: A system in which there is a separate database at each school in the district. Each database only contains records for students attending that school. Does not have the capability to automatically aggregate data across the district. Although many applications will in theory run on larger district networks, most are not designed to be used over the slow wide-area-networks that most districts use.
  • 40. Multiple School Use: Allows the user to record data from several schools on a single computer. Typically used when each school does not have its own computer. There may be a fee for each additional school. Networkable: The software package is designed to be used by multiple users on a network. Some software applications can only be used on a local network that exists in a single building, while others can be used on a wide-area-network across all schools in the district. Online Help: A basic help function available to the user which is part of the software itself; it is usually accessed via a help “menu.” Password Security: If the program has a password security system, a password, which is created by the nurse, is needed to gain access to the software system. Print Individual Records: Allows the user to print reports containing the records of individual students. Record Multiple Diagnoses: Several diagnoses may be entered for one visit. Each of the diagnosis entered may be used to generate a report or list. Special Emergency This is a file that is quick and easy to access that is outside of the Information Files: student record. The file contain emergency information such as the phone number of the student’s parents and primary care physician Student Activity Record: A section of the individual student record that keeps track of school activities in which the student participates, such as marching band, sports activities or clubs. Technical Assistance Telephone help, training, fax-back services, and other assistance. Available:
  • 41. References Balter, A. Alison Balter’s Mastering Access 97. Indianapolis, IN: SAMS Publishing, 1997. HL7 Interoperability Standards. www.hl7.org. Massachusetts Department of Education, Software Compliant With the Student Information Management System. www.doe.mass.edu/edtech/administrative/ims/sims_compliance.html. Massachusetts Department of Education, State Regulation 603 CMR 23.00 (Student Records). NCES Task Force. Technology @ Your Fingertips: a guide to implementing technology solutions for education agencies and institutions. National Center For Education Statistics, U.S. Department of Education, 1998. GPO # 065-000-01097-6. (On the web: nces.ed.gov/pubsearch/, NCES document # 98293.) North American Nursing Diagnosis Association. www.nanda.org/. Nursing Interventions Classification. www.nursing.uiowa.edu/nic/overview.htm. School Interoperability Framework. www.schoolsinterop.org. Szuba, Tom. and the Technology and Security Task Force of the National Forum on Education Statistics. Safeguarding Your Technology: Practical Guidelines for Electronic Education Information Security. National Center For Education Statistics, U.S. Department of Education, 1998. GPO # 065-000-01182-4. (On the web: nces.ed.gov/pubsearch/, NCES document #98297.) (Guidelines written in non-technical language to help educational administrators and staff at the buildings, campus, district, and state levels better understand why and how to effectively secure their organization's sensitive information, critical systems, computer equipment, and network access.) Viescas, J. Running Microsoft Access 2000. Redmond, WA: Microsoft Press, 1999.